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An Anatomical Approach to Determine the Location of the Sinoatrial Node During Catheter Ablation
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  • Keiko Shimamoto,
  • Kennichiro Yamagata,
  • Kenzaburo Nakajima,
  • Tsukasa Kamakura,
  • Mitsuru Wada,
  • Yuko Inoue,
  • Koji Miyamoto,
  • Takashi Noda,
  • Satoshi Nagase,
  • Kengo Kusano
Keiko Shimamoto
National Cerebral and Cardiovascular Center
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Kennichiro Yamagata
National Cerebral and Cardiovascular Center
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Kenzaburo Nakajima
National Cerebral and Cardiovascular Center
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Tsukasa Kamakura
National Cerebral and Cardiovascular Center
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Mitsuru Wada
National Cerebral and Cardiovascular Center
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Yuko Inoue
National Cerebral and Cardiovascular Center
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Koji Miyamoto
National Cerebral and Cardiovascular Center
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Takashi Noda
National Cerebral and Cardiovascular Center
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Satoshi Nagase
National Cerebral and Cardiovascular Center
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Kengo Kusano
National Cerebral and Cardiovascular Center
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Abstract

Introduction: The sinoatrial node (SAN) should be identified before superior vena cava (SVC) isolation to avoid SAN injury. However, its location cannot be identified without restoring sinus rhythm. This study evaluated the usefulness of the anatomically defined SAN by comparing it with the electrically confirmed SAN (e-SAN) and aimed to establish a safe and more efficient anatomical reference for SVC isolation than the previously reported reference of the roof of the right superior pulmonary vein (RSPV roof). Methods and Results: The e-SAN was identified as the earliest activation site in the electro-anatomical map obtained during sinus rhythm. The anatomically defined SAN, the cranial edge of the crista terminalis (CT) visualized with intracardiac echocardiography (CT top), and the RSPV roof were tagged on one map. The distance from the e-SAN to each reference was measured. Among 81 patients, the height of the e-SAN from the CT top was −3.5 ± 10.3 mm. The e-SAN existed below 10 mm above the CT top in 78 (96%) patients and below the RSPV roof in 77 (95%) patients. A longer SVC sleeve was measured from 10 mm above the CT top compared to the RSPV roof (28.7 ± 11.2 vs. 22.5 ± 11.3 mm, p <0.001). Faster heart rate predicted an e-SAN location higher than the CT top (adjusted OR [95% CI]; per 10 bpm increase: 1.6 [1.15–2.22], p <0.01). Conclusion: The CT top is useful in predicting the upper limit of the e-SAN and can provide a useful reference for SVC isolation.

Peer review status:ACCEPTED

13 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
14 Nov 2020Submission Checks Completed
14 Nov 2020Assigned to Editor
16 Nov 2020Reviewer(s) Assigned
10 Dec 2020Review(s) Completed, Editorial Evaluation Pending
20 Dec 2020Editorial Decision: Revise Minor
22 Jan 20211st Revision Received
23 Jan 2021Assigned to Editor
23 Jan 2021Submission Checks Completed
23 Jan 2021Reviewer(s) Assigned
01 Feb 2021Review(s) Completed, Editorial Evaluation Pending
02 Feb 2021Editorial Decision: Revise Minor
09 Feb 20212nd Revision Received
09 Feb 2021Submission Checks Completed
09 Feb 2021Assigned to Editor
09 Feb 2021Reviewer(s) Assigned
15 Feb 2021Review(s) Completed, Editorial Evaluation Pending
16 Feb 2021Editorial Decision: Accept